Healthcare is not known for its amazing customer experience. The nation’s health system is notoriously complex, requiring plenty of administrative work from patients to sift through their benefits, find available providers or collect their health data.
But artificial intelligence could begin to ameliorate some of the sector’s complexity, according to Nathan Frank, chief digital and technology officer at Aetna. The CVS Health-owned insurer has rolled out new digital tools that aim to help beneficiaries navigate their care, like a conversational AI assistant and a product called Care Paths that guides patients with specific conditions through their benefits and next steps.
“We believe that it’s going to change the consumer healthcare experience,” he said. “We think it’s going to continue to advance the clinical experience and really improve the ability for us to meet our members and provide better clinical outcomes.”
Frank sat down with Healthcare Dive to discuss how Aetna is using AI to engage members, how the insurer thinks about risks associated with the technology, and the importance of monitoring the products’ performance and soliciting feedback.
This interview was edited for clarity and length.
HEALTHCARE DIVE: How is Aetna thinking about using AI to communicate with your members? I know you recently rolled out a conversational AI assistant.
NATHAN FRANK: So, we took a little bit of a different approach to that. We also have the ability to have a chat experience through our digital properties, but we actually embedded the Ask Anything capability. So no matter where you’re at in our app or web experience, you’re going to get the ability to ask anything in natural language. You’re going to get a full response that might provide you a map to your provider. It might provide a next best action. It might start to give you information that you might not even be thinking about. And then we’re using something called GenUI, which actually modifies that experience personally for you.
There’s a real world advantage to that. Less calls to our call centers. If members can get an answer very quickly on our web and app properties, they don’t want to have that phone call. We also know that healthcare is deeply personal. A lot of our members, if they have a chronic condition or are recently diagnosed with cancer, they want to call us. They want to get someone on the phone, they want to talk to a member services rep or a care manager.
Now we have the opportunity on the back end to provide [our member services representatives] with all of the same AI-powered tools we provide our members on the front end. So our member services reps know who the caller is. They know if they went to digital [properties], they know the question that they asked. And then we start to anticipate the answers for our member services folks so they can actually focus on being empathetic to the member during these situations, versus scrambling around looking for four different docs or the answer to a complex benefit question.
How do you handle the potential risks of using AI, like providing inaccurate information to a member?
We want to make sure that AI is not a black box — fully explainable, fully transparent where we’re using AI. We’re spending a lot of time and effort putting the guardrails around no bias and hallucinations, and making sure we monitor and measure that constantly.
Our experts in the business segments — that might be a clinician, that might be a nurse — are partnering with us, sitting in a small group of people developing these solutions. They also have the ability to provide instant feedback. If we’re summarizing clinical information using AI, we want to rely not only just on the technology to make sure that the guardrails are there, but we want to make sure those 15,000 nurses [that work for us] have the ability to say, “Hey, that didn’t work properly” or, more importantly, after an interaction: “That worked awesome.” And so we get that instant feedback, and that’s helped us make sure we’re providing the best experience.
So we have a robust AI governance model at scale that we’ve put into place. It makes sure that we're putting the right guardrails in there, we monitor it, and then we want to make sure, from an experience perspective, we have that connection back to the people that are using it every day.
You mentioned the importance of monitoring AI. What does the process look like? How do you think about the consistent monitoring and the workforce you need to maintain to make sure the AI is working well?
That’s sort of the beauty of technology. We have a really amazing set of product managers and engineers who are constantly monitoring and tuning the back end. That’s real time monitoring through technology tools, but also on a regular basis, retrospective monitoring of the data and how it’s being used.
And then from a front-end experience perspective, you want to make sure that we’re providing the best experience so they can provide feedback there. So once you combine those two, you’re talking about using the actual technology and data and then the experience on the front end.
I'll just give you an example: clinical call summarization. We started out with a relatively small group to make sure we got it right. This would be a test and learn experience. We would run that for a period of time, make sure that we have the right transparency, monitoring, measurement, and we’re comfortable. Then we start to expand it, and then that’s where the tuning comes in to give us that optimized experience.
What has beneficiaries’ reaction to AI tools been like? I imagine some members might not want to talk to an AI, but they could value getting information more quickly.
Every member is different, right? Some members want to have a conversation via phone call. Some never want to call. Some want to be able to do it digitally. And so we look at success in a couple of different ways. With Care Paths, we’ve been able to reduce calls around maternity, diabetes and [musculoskeletal conditions] by [8.6%]. And the reason why is because they’re having a really good experience in the app, so they don’t have to call.
For those three conditions, we’ve actually increased the digital engagement by 38%. So you’re pregnant, you want to understand what your benefits are. You opt into a Care Path for maternity on our app, we’re going to give you a personalized, condition-focused view of what’s next for you, what you might need to do, what questions you want to ask your provider. We also give you the instant ability — if you want to have that live connection — to click on a button and talk to a care manager on your team.
We’ve seen our customer [satisfaction] continue to go up because the digital experience is improving. AI is helping with that.
